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I,                                                                  , understand that the massage therapy is intended to enhance relaxation, reduce pain caused by muscle tension, increase range of motion, improve circulation and offer a positive experience of touch. Any other intended purposes for massage therapy are specified below:
The general benefits of massage, possible massage contraindications and the treatment procedure have been explained to me. I understand that massage therapy is not a substitute for medical treatment or medications, and that it is recommended that I concurrently work with my Primary Caregiver for any condition I may have. I am aware that the massage therapist does not diagnose illness or disease, does not prescribe medications, and that spinal manipulations are not part of massage therapy.
I have informed the massage therapist of all my known physical conditions, medical conditions, and medications, and I will keep the massage therapist updated on any changes. I understand that there shall be no liability on the practitioner's part due to my forgetting to relay any pertinent information.
If I experience any pain or discomfort during the session, I will immediately communicate that to the therapist so the treatment can be adjusted.
I understand and abide by the therapist's policies and will not hold Sandra Beltramini, LLC or the therapist responsible for any personal injury or loss of property.

*Please sign within box. If you are having issues, please fill out this form via computer.*

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